合并肝硬化老年患者骨折术后镇痛的循证治疗

Evidence-based Postoperative Analgesic Treatment for Femur Fracture Patient with Liver Cirrhosis

目的为1例合并肝硬化老年骨折患者制定镇痛方案,检索当前最佳证据,减少并发症发生。方法 2013年7月9日收治1例合并肝硬化老年骨折患者,针对患者术后镇痛治疗问题,全面评估病情,检索数据库获得循证医学证据,制定最佳治疗方案,治疗始末均全面实施该方案,评价治疗结局。结果检索纳入22篇文献,其中临床指南1篇,Cochrane系统评价3篇,系统评价5篇,小样本临床随机对照试验7篇,高质量观察性研究1篇,高质量的专题综述5篇。上述文献显示,在对肝硬化术后患者进行术后镇痛治疗时联合应用非阿片类镇痛药和阿片类镇痛药可以降低单独应用阿片类药物的使用量,从而降低阿片类药物不良反应的发生,增加镇痛安全性。环氧化酶2抑制剂不良反应较少,镇痛效果良好,可作为非阿片类镇痛药的首选药物。结论通过循证方法治疗合并肝硬化老年骨折患者的疼痛,更具有科学性和有效性。

Objective To provide references for postoperative analgesia treatment for cirrhotic patients with bone fracture. Methods One elderly patient with liver cirrhosis and fracture was admitted to our hospital on July 9, 2013. We obtained medical evidences by searching databases and regulated the best treatment after evaluating the patient＇s comprehensive conditions. And then, the whole treatment strategy was fully implemented. Finally, the consequent results were evaluated. Results We identified 22 relevant articles including one clinical guideline, three cochrane reviews, five systematic reviews, seven small sample randomized controlled trials, one high quality observational study, and five quantitative reviews. We found that opioid analgesics utilization combined with non-opioid analgesics could not only reduce the occurrence of opioid drug adverse reactions, but increase analgesia safety. Cox-2 inhibitors could be used as the first choice of non-opioid drugs due to the less adverse reaction and better analgesic effectiveness. Conclusion For femur fracture patients with liver cirrhosis, treatment decision based on evidence-based medicine is more scientific, which can ensure maximum benefit for the patients.